Definition

Ovarian cancer is a disease in which cancer cells grow in the ovaries. The ovaries are a pair of organs in the pelvic area of women. The ovaries produce eggs and female hormones.

Cancer occurs when cells in the body (in this case ovarian cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

The most common type of ovarian cancer is epithelial (serous, mucinous, transition, mixed, and Brenner). Many of these tumors are cystic and may grow to be very large without producing symptoms. Because of this, and because these tumors can be hard to find on physical examination, about 70% of these patients present with advanced disease.

Germ cell tumors (choriocarcinoma, yolk sac tumor, dysgerminoma, teratoma, and embryonal cell carcinoma) come from the reproductive tissue and account for about 20% of tumors. More rare are stromal (Sertoli, Leydig, and granulosa cell ) cancers, which arise from the connective cells of the ovary and typically produce hormones which produce symptoms (such as development of male patterns of hair growth, loss of menstrual periods, or increased menstrual bleeding).

Cancerous Mass in the Left Ovary

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Causes

The causes of ovarian cancer are not known. However, research shows that certain risk factors are associated with the disease.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Family history of ovarian cancer, especially in mother, sister, or daughter
  • Age: 50 or older
  • Menstrual history—first period before age 12, no childbirth or first childbirth after age 30, and late menopause
  • Personal history of breast cancer or colon cancer
  • Presence of certain gene mutations, including BRCA1

Use of birth control pills for more than five years appears to decrease risk.

Symptoms

Ovarian cancer generally doesn't cause symptoms until the later stages.

Symptoms include:

  • Abdominal discomfort and/or pain
  • Gas, indigestion, pressure, swelling, bloating, or cramps
  • Nausea, diarrhea, constipation, or frequent urination
  • Loss of appetite
  • Feeling of fullness even after only a light meal
  • Unexplained weight gain or loss
  • Abnormal bleeding from the vagina
  • Hair growth, voice deepening, acne, loss of menstrual periods in some rare stromal tumors

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

Diagnosis

Your doctor will ask you about your symptoms and medical history, and perform a physical examination.

Tests may include:

Pelvic Exam

Use of a physician's gloved finger to examine the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for lumps or a change in size or shape.

Imaging Tests

Tests that create pictures of the ovaries and surrounding tissues that will show if there is a tumor including

  • Ultrasound
  • CT scan
  • MRI scan
  • Lower GI Series or barium enema— injection of fluid into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal spots.
  • CA-125 assay—a blood test to measure the level of CA-125, a substance in the blood that may be elevated if ovarian cancer is present

Treatment

General Approach

The general approach to patients with ovarian cancer is to first undergo as complete a surgical procedure as possible. This must be performed by a qualified gynecologic oncologist.

During this first surgery, if ovarian cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment for ovarian cancer depends on the extent of the cancer and the general health of the patient. Thereafter, and based on the findings, patients then usually receive chemotherapy. Sometimes, radiation therapy of the abdomen is offered. The most appropriate therapy is based on the experience of the treating physicians and the toxicities expected.

Treatments include:

Surgery

Surgical removal of a cancerous tumor and nearby tissue, and possibly nearby lymph nodes.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Radiation Therapy (Radiotherapy)

Radiation therapy (radiotherapy) is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

  • External radiation therapy—radiation directed at the abdomen from a source outside the body
  • Intra-abdominal P32—sometimes a radioactive solution may be introduced into the abdomen as part of treatment

In general, the more advanced the tumor at diagnosis, the poorer the prognosis. Unfortunately, 75% of all epithelial tumors are stage 3 or 4 at the time of diagnosis, and the overall five year survival rate is about 50%.

Prevention

There are no guidelines for preventing ovarian cancer because the cause is unknown and symptoms are not present in the early stages. If you think you are at risk for ovarian cancer, talk to your doctor about ways to reduce your risk factors. Also schedule check-ups with your doctor if needed. All women should have regular physical examinations, including vaginal examination and palpation of the ovaries, as part of their routine medical care.